Addressing and Managing Erectile Dysfunction after Prostatectomy For Prostate Cancer

Jeffrey A. Albaugh, PhD, APRN, CUCNS

Disclosures

Urol Nurs. 2010;30(3):167-177,166. 

In This Article

Conclusion

Erectile dysfunction after radical prostatectomy remains one of the most common adverse side effects of treatment. Although some men might not be concerned about erectile function, many men are distressed about this problem and need assistance in determining the best way to move forward to promote and preserve erectile function. Each treatment option has both positive and negative aspects. Patients need to not only decide how and if they want to treat erectile dysfunction, but also make choices in terms of penile rehabilitation to promote blood flow to the penis to promote return of spontaneous erections. Each individual patient has his own unique sexual expression, and the patient and health care professional together can carefully determine how a potential treatment would work within that particular patient's life.

Treatment of erectile dysfunction after prostatectomy can be challenging since there is no definitive evidence to support a particular treatment option over the others. Generally, patients tend to start with less invasive or less cumbersome options. Most patients prefer oral agents because they are discreet and easy to utilize, and if appropriate, this can be a first line treatment. Since failure rates for oral agents remain very high post-prostatectomy, patients should be provided with other more efficacious options for use either instead of or in combination with oral agents to provide sufficient erectile function. Despite the fact that oral agents do not always provide sufficient erectile rigidity for penetrative sex, they have been shown to improve nocturnal erections and blood flow to the penis in post-prostatectomy men (Montorsi et al., 2000; Schwartz et al., 2004). It is crucial for the health care professional to provide appropriate education about the use of oral agents for penile rehabilitation, even if medication is not resulting in a full erection so patients will be encouraged to continue this therapy for penile rehabilitation. In addition, other treatments, such as the vacuum device or Muse, can be used in conjunction with the oral agents to enhance erections and penile rehabilitation. Although the vacuum device is associated with high efficacy and is the least invasive treatment option, it is cumbersome. Another relatively simple treatment option is Muse. Important factors regarding Muse are the issue of pain with alprostadil use after radical prostatectomy and the cost factor. If a patient wants proven efficacy and is highly motivated to carefully use a treatment, penile injections may be the best choice. Finally, when medical treatments have failed, the patient may want to consider a penile implant. The implant provides an effective treatment associated with high patient and partner satisfaction, but not all men are willing to undergo this surgically invasive intervention.

It is critically important for patients to understand that not utilizing any treatment to promote cavernosal blood flow and oxygenation will have long-term ramifications for regaining erectile function in the future. Each year, more research continues to reveal the importance of using treatment for erectile dysfunction to promote corporal tissue health and diminish atrophic changes to the penile tissue. After prostate surgery, nitric oxide synthesis is diminished due to nerve trauma to the cavernosal nerve (Carrier et al., 1995). The lack of nitric oxide and neuropraxia lead to diminished blood flow and oxygenation of the penile tissue, which leads to cavernosal fibrosis and collagen synthesis (Leungwattanakij et al., 2003). Atrophy and penile fibrosis cause further erectile dysfunction after radical prostatectomy; therefore, re-establishing blood flow to the penis is important to preserve and promote optimal erectile function in these men.

By understanding each treatment option and determining the best choice for treatment, health care professionals can help patients find the optimal treatment option for erectile dysfunction and penile rehabilitation. The health care team can help each patient carefully consider their unique sexual lifestyle and how to incorporate erectile dysfunction treatment into their sexual experience so this important component of life need not be lost after prostatectomy.

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